Neurosurgery
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Randomized Controlled Trial Multicenter Study Clinical Trial
Grading of subarachnoid hemorrhage: modification of the world World Federation of Neurosurgical Societies scale on the basis of data for a large series of patients.
The goals of this study were to use a large, prospectively collected, multicenter database for patients with aneurysmal subarachnoid hemorrhage (SAH) who were treated between 1991 and 1997 to determine the prognostic significance of clinical and radiological factors for outcomes and to use those factors to develop a grading scale to predict outcomes. ⋯ Outcome prediction after SAH can be improved by adding additional clinical and radiological factors to the WFNS scale, albeit with added complexity.
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To investigate the effects of mild hypothermia on brain microdialysate lactate after fluid percussion traumatic brain injury (TBI) in rats. ⋯ The cerebral extracellular fluid lactate level increases significantly after fluid percussion brain injury. Preinjury mild hypothermia completely inhibits the cerebral lactate accumulation, and early postinjury mild hypothermia significantly blunts the increase of cerebral lactate level after fluid percussion injury.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Intraventricular thrombolysis speeds blood clot resolution: results of a pilot, prospective, randomized, double-blind, controlled trial.
Animal models and clinical studies suggest that intraventricular thrombolysis improves clot resolution and clinical outcomes among patients with intraventricular hemorrhage. However, this intervention may increase the rates of rebleeding and infection. To assess the safety and efficacy of intraventricular thrombolysis, we conducted a pilot, randomized, double-blind, controlled, multicenter study. ⋯ Intraventricular thrombolysis with urokinase speeds the resolution of intraventricular blood clots, compared with treatment with ventricular drainage alone.
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Comparative Study
"Tangential" resection of medial temporal lobe arteriovenous malformations with the orbitozygomatic approach.
Arteriovenous malformations (AVMs) of the medial temporal lobe are usually resected through subtemporal-transcortical approaches that provide a trajectory that is perpendicular to the plane of the AVM. The pterional approach is sometimes used for AVMs in the uncus and amygdala, but it is not recommended for AVMs in the hippocampal region because it provides a "tangential" approach with limited access to posterior feeding arteries and draining veins. The orbitozygomatic approach enhances exposure along this tangential trajectory and was used in a consecutive series of 10 patients to determine its advantages. ⋯ The orbitozygomatic approach maximizes the exposure of the tangential approach to medial temporal lobe AVMs and has advantages over traditional lateral approaches. It provides early access to critical feeding arteries from the anterior choroidal artery, posterior cerebral artery, and posterior communicating artery; it minimizes temporal lobe retraction and risk to the vein of Labbé; and it avoids transcortical incisions or lobectomy that might impact language and memory function. For these reasons, it may be the optimal approach for small- and medium-sized compact AVMs in the dominant medial temporal lobe.